Telehealth Portal Expands its Exclusion Monitoring During COVID-19

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The following case study is an example of a ProviderTrust customer who is a large telehealth provider which offers virtual care solutions for providers, insurers, patients, and industry leaders.

During COVID-19, telehealth and virtual care delivery have steadily increased to meet the needs of social distancing and safe medical practices. ProviderTrust partners with multiple telehealth solution industry leaders and we continue to learn more about how to support their operations.

In this case study, we’ll review some of the expansion that has occurred as providers have been onboarded onto the telehealth platform since the start of COVID-19, and how we’ve helped support effective ongoing exclusion monitoring for providers and employees.

Telehealth Provider Profile

This customer is a large telehealth solutions provider that partners with many health systems, health plans, and individuals. This organization supports the largest ecosystem of healthcare partners for both acute and non-acute care.

Prior to the COVID-19 pandemic, this partner was monitoring more than 4,000 providers for federal healthcare program ineligibility. Over the course of the last 4 months, they have more than doubled this population to include nearly 11,000 individuals being monitored for exclusions or sanctions.

In addition to monitoring healthcare exclusion sources such as the OIG LEIE,, and state Medicaid lists, the organization was also responsible for making sure no providers were on the Medicare Opt Out list.

Monitoring Employees for Exclusions

It’s important to monitor your employees for any healthcare exclusions. If you participate in federal healthcare programs, you are responsible for ensuring that no one involved is excluded or ineligible to participate. Currently, the customer is monitoring close to 200 employees in our Passport solution.

The Challenge

The customer was looking to find a data partner who could scale with their growth and easily add any sources they needed for ongoing monitoring of their various customers and internal staff. As mentioned above, the Medicare Opt Out list was important to incorporate quickly and accurately, something that a previous vendor was not able to perform.

It was important for the customer to have a proactive and timely solution to address business decisions when providers were found on the Medicare Opt Out list. When this occurs, a contract must be terminated for certain lines of business and in compliance with the Centers for Medicare and Medicaid Services (CMS) and HHS OIG standards.

Finding a tool that team members felt confident in utilizing each day, and administrators could count on for visibility and accuracy was essential to implementing our solution across the organization and department.

Partnership Goals

  • Establish trust with an exact-match solution that is reliable and identifies areas of risk and concern
  • Reduce additional verification or false-positives for excluded or sanctioned providers or employees
  • An intuitive platform that can easily be adopted by team members and utilized by administrators for high-level results
  • Centralize provider data and ongoing monitoring records in one platform
  • Monitor healthcare providers and employees for any exclusions or sanctions from HHS OIG,, or state Medicaid authorities
  • Ongoing monitoring of the Medicare Opt Out list to stay compliant and make timely informed decisions
  • Optimize team workflows with aligned policies, controlled processes, and increased accountability
  • Create dashboard views to meet compliance and reporting requirements

Health Policy Expert Explains COVID-19 Impact and Telehealth Expansion [Video]

Watch the recording.

How We Helped

  • Automated monthly exclusion monitoring for providers and employees with exact-match results
  • Our Passport solution has identified excluded, sanctioned, or terminated providers in their populations
  • Provided a trustworthy solution for ongoing Medicare Opt Out monitoring and process improvement
  • Successful onboarding and team adoption with optimized workflows and reporting
  • Shared insights and transparency for their team
  • Enhanced reporting options for smoother audits and quick lookup of provider verification and monitoring history

Customer Review

We are so pleased with our partnership with this customer and continue to learn from their unique challenges and opportunities each day to help address the needs of patients and healthcare organizations. ProviderTrust aims to make their lives a little easier by providing helpful tools and customer service for increased clarity while onboarding and monitoring providers, clinicians, and employees.

Our team celebrates their success in having a trustworthy process to quickly alert and align their focus when compliance issues arise in any of their healthcare populations.

ProviderTrust continues its mission to create smarter and safer healthcare by empowering healthcare professionals with automated solutions that impact patient care on a daily basis.

How are you navigating the expansion of telehealth and updated rules for COVID-19?

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